By twelve votes, the Scottish parliament rejected the assisted dying for terminally ill adults bill on March 17.

The debate that preceded it was emotionally charged and, at moments, genuinely moving. MSPs spoke of parents, partners, faith and fear. Much of it turned on the contents of the bill – safeguards, eligibility criteria and conscience clauses. The structural conditions in which terminally ill people in Scotland actually make decisions received less attention, and what attention they did receive struggled to translate into demands that any future legislation must meet.

Scotland is an unequal place to live. In its most deprived communities, life expectancy has been falling since 2013; a gap of more than 13 years now separates the richest and the poorest. And the people at the bottom of that gap do not simply die younger.

A 2012 study of 1.72 million Scottish patients found that having multiple long-term conditions begins ten to 15 years earlier in the poorest communities than in the wealthiest. Among the most disadvantaged of our society, the diseases that lead to terminal illness arrive sooner, in greater number and are compounded by poverty.

Scotland is also, by the measures that matter most, a deeply unequal place to die. Around 6,400 terminally ill Scots spend their final months below the poverty line. One in five die in fuel poverty. The additional costs of dying (equipment, housing adaptations, heating, transport, care) amount to between £12,000 and £16,000 in the final year of life........

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